Increasing access to services is a slam dunk for improved campus mental health

With the arrival of March, the country’s sports-watching public made its annual pivot from the Super Bowl to the student athletes across the nation vying to win the NCAA men’s basketball tournament. “March Madness”, as it is known colloquially, is a beloved sporting event – marked by students’ passion for their team in pursuit of its “one shining moment”.

The students’ excitement we see on vivid display at the tournament games belies the hardship many of them endure as they struggle with untreated or under-treated mental illnesses. A study recently released by STATnews, a national publication on health, medicine, and scientific discovery, found that access to mental health services on many college campuses is insufficient to provide adequate treatment to their students. According to a STATnews survey conducted across 50 schools, respondents noted that the ratio of undergraduate students to a provider ranged from 400:1 to 1500:1, leading to wait times of up to three weeks for a counseling appointment.

Wait times – which may be significantly more during peak periods such as finals – can be intolerable for students in a brand new environment facing more intense stressors than ever before. From 2009-2015, utilization of services grew at a rate that is more than five times that of enrollment while the majority of counseling center operating budgets (~60%) remained unchanged from 2014-2015, according to the 2015 report of the Center for Collegiate Mental Health. There are many likely reasons for the rising need. As the STATnews article states, “factors may include increased pressure from parents or peers on social media, or a difficult job market. Another possible reason: increased awareness about the risk of mental health conditions.” In addition, most men who are diagnosed with psychosis have their first symptoms in their early 20’s, many while still pursuing their degrees.

From 2009-2015, utilization of services grew at a rate that is more than five times that of enrollment while the majority of counseling center operating budgets (~60%) remained unchanged from 2014-2015.

No need to reinvent the wheel

Universities can adopt lessons learned from other areas of behavioral health. Two innovative strategies that address access-to-care issues come to mind:

Increase the use of tele-mental health (TMH). TMH allows psychologists and psychiatrists to practice medicine remotely, increasing their capacity to provide appointments across state lines and without time-intensive travel. It also potentially increases both convenience and privacy for students, who may be able to attend a virtual face-to-face counseling session in the comfort of their dorm room or on their phone via text. Colleges can tap into this network of providers to meet excess demand. In a 2015 survey, only 9.1% of counseling centers indicated that they were offering some form of TMH, indicating significant room for expansion.

Change the payment structure. While many university-based counseling centers have salaried full-time staff, others have contracted providers who are typically paid on a fee-for-service basis, creating a focus on volume of services rather than quality. Rigid reimbursement methodologies often constrain providers to a set of predetermined services. Conversely, a unique payment scheme that focuses on value allows the provider to target how to prioritize patients and be flexible in the types of treatment (e.g., group vs. individual counseling) he/she offers in order to get the most out of its resources. In a change that could impact salaried employees as well, compensation can be tied to outcome measures, such as time between call and appointment, follow-up rates, average time in treatment and patient-reported satisfaction surveys. In an environment where 20% of the utilizers are using 50% of the capacity, targeted approaches can yield impactful results.

Undoubtedly, there are other ways to address these issues on campus as well. The important point is that the issues get the attention and resourcing required to make a difference. Universities face the challenge of making sure their students develop in a supportive environment that allows them to continue to showcase their enthusiasm that basketball lovers and others can witness and enjoy. Let’s hope they’re up to it. There’s more than just a busted bracket at stake.

Good article with actionable strategies that could help to resolve this crisis. My only complaint is perhaps a bit off target but legitimate just the same. March Madness includes both the men’s and women’s Tournaments. Failure to mention the women’s participation is a glaring oversight that fails to support the equality that our society has been striving to achieve for many years.

The Tele-Mental Heath idea might work in some cases, but I would be concerned with practicing medicine across state lines. There is an awful lot of liability and exposure with this concept. Also, I think many cues about the state of the individual’s mental health could be missed with the anonymity of the encounter instead of something face-to-face. Perhaps Skype would be helpful. Better yet, maybe teaching kids to handle stressors before getting to college would help. That would take better parenting skills. Technology can’t solve all our problems.